- Email: [email protected]
M435 POSTPARTUM URINARY DISORDERS
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
M434 EVALUATION OF DIAGNOSTIC TESTS IN URINARY INCONTINENCE (UI) AND RESULTS OF SURGERY FOR UI WITH OR WITHOUT PROLAPSE M.L. Sanchez-Ferrer1 , M.A. Moreno1 , F. Machado1 , P. Vivaracho Terrer1 , A. Nieto1 , J.J. Parrilla1 . 1 Hospital Universitario Virgen de la Arrixaca, Murcia, Murcia, Spain Objectives: Assess the results obtained in the absence/persistence of SUI (stress urinary incontinence) or incontinence ’de novo’ Difference in results of incontinence in patients operated. Assess differences in the diagnosis of UI based on: the urodynamic test compared to incontinence test to assess what has more diagnostic reliability, analyzed according the results obtained. Percentage of patients who required adjustment TOT. Materials: Selected 52 patients operated for UI, pelvic organ prolapse with IU or occult urinary incontinence (OUI). The surgery were vaginal hysterectomy (VH) with or without associated incontinence type transobturator tension-free (TOT). Methods: Statistical analysis was performed using the SPSS program. Results: According to medical history of IU, 43% reported stress urinary incontinence (SUI), 24.5% mixed urinary incontinence (MUI), 9.4% reported urge incontinence (UUI), and 22.6% reported no UI. The surgeries performed were: 30 VH +TOT, 15 TOT, 7 VH Total post-operative results: 85.9% not had SUI, 17.5% had UUI, after anticholinergic treatment only 14%. Breaking down the results of surgery performed: In patients operated TOT 60% had SUI, none of them had SUI after surgery, 13% MUI, 13% IUU ’de novo’; 40% had prior MUI, of these 33% had MUI later. Of the patients operated VH + TOT: Only 10% had postoperative SUI, of which the previously manifested 66% and 33% had occult stress urinary incontinence. 21% of the patients didn’t match the diagnosis made with the urodynamic incontinence in test of 300 ml. Concerning the need to adjust the TOT only 17.5% required postoperative adjustment in all cases except one, the adjustment was to increase the tension. Conclusions: Results were satisfactory. According to the ranges described in the literature. We found that after surgical repair (plasty) of prolapse were resolved on 75% of cases of IUU. Comparing results of TOT with or without VH we find that overall results are slightly better for isolated TOT. We also compared the diagnostic test of incontinence in medical consultation compared with urodynamic study and the results were: 21.15% of cases no diagnosis agreed, but we have observed that when different if only one of them diagnosed with SUI, incontinence surgery was performed and postoperative result was satisfactory. In our sample were adjusted to 17% of TOT ± VH thereafter and we think this action improved our results. M435 POSTPARTUM URINARY DISORDERS M.F. Nozar1,2 , F. Aroztegui2 , M. Kouyoumdjian2 , T. Bengoechea2 , Z. Caraballo2 , D. Greif1,2 , L. Briozzo1,2 . 1 Gynecology, School of Medicine. University of the Republic, Montevideo, Uruguay; 2 Obstetric and Gynecology Department A, Pereira Rossell Hospital, Montevideo, Uruguay Objectives: To assess the prevalence of postpartum urinary disorders and their relationship to birth-related variables. Materials: Population: 140 women between 18 and 40 years, with term pregnancies, live fetuses, and no history of voiding dysfunction prior to delivery. Methods: Prospective study. Place: maternity of the Pereira Rossell Hospital, Montevideo, Uruguay. Period: November 15 to December 14, 2011. Was assessed the onset of voiding disorders related to: route of delivery, parity, perineal laceration, episiotomy, and birth weight.
S671
The survey of the Mountain States Urogynecology, Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) by telephone follow-up at 7 and 30 days of birth was applied. Results: The mean population age was 25.5 years. 62 patients (44%) had voiding dysfunction postpartum. Of these last, 40% referred urgency, 26% stress urinary incontinence, 19% difficulty bladder emptying and 40% genital or lower abdominal pain after 7 days of delivery. Whereas at 30 days postpartum frequency of these symptoms was: 48%, 39%, 18% and 26%, respectively. 48% of vaginal deliveries, 43% of instrumental deliveries and cesarean sections 34% had a postpartum disorder. 57% of the patients who had a birth that higher than 4000 grams had some symptom. 31% and 45% of symptomatic patients referred involvement in daily activities and 29% and 44% of your emotional health at 7 and 30 days respectively. Conclusions: Postpartum urinary disorders are frequents en this population. Women may have multiple symptoms that often go unnoticed, resulting in impact to the biological, social and sexual live. M436 THE ROLE OF MESH REPAIR IN VAGINAL PROLAPSE R. Singh1 , V.P. Singh2 , L. Ravikanti2 . 1 Palmerston North Hospital, Palmerston North, New Zealand; 2 Waikato Hospital, Hamilton, New Zealand Objectives: 1. To assess the efficacy of vaginal mesh repair in patients with paravaginal defects. 2. To compare mesh systems available worldwide. 3. To identify complications and compare our results with other investigators worldwide. Materials: Single surgeon/supervision, including all patients undergoing customized Gynemesh repair for cystocele. Patients were followed up, data analyzed & compared with others systems/ researchers worldwide. Methods: Multicentric study analyzing data over time. Includes objective, subjective and patient quality of life indices. Review of literature worldwide & comparison of results. Results: Newer techniques/materials are contantly being developed indicating better understanding and a felt need for improvement in management techniques, and need for better results and further reducing risks/complications. Most patients in our study were in the 41–70 age group with mainly stage 3 prolapse. 36% (41/114) had previous surgery for prolapse. 95/114 needed anterior & posterior mesh repair. 21/114 needed a concomitant suburethral sling. Subjective & objective cure rates were 100% and 92% respectively. 14/93 & 6/114 developed short term denovo USI & buttock pain. 4/114 developed mesh erosion. Complications decreased with increasing experience. Conclusions: Our understanding of the mechanism of prolapse and optimal management is evolving. Our Technique is a quick, safe, reliable & less expensive than Mesh systems & with fewer complications than most other techniques. The Use of prosthesis have improved results & gained acceptance over time. Newer products/techniques give us reason to hope for improvement in quality of life & a better future for our patients but challenges remain. M437 NEW DEVICE TO SACROSPINOUS SUSPENSION OF APICAL PROLAPSE OR GREAT CYSTOCELE BY ANTERIOR APPROACH J. Elias1 , A. Carbone1 , A. Gaspar1 . 1 Sociedad de Obstetricia y Ginecologia de Buenos Aires (SOGIBA), Buenos Aires, Argentina Objectives: The most modern concepts of anatomy and physiology of prolapse (Prof. DeLancey – Lisbon 2011) indicate the need for all large anterior prolapse repairs to suspensions or reinforcements at level 1. We treated a group of patients with a new device, designe by the company for Argentina Promedon, that makes it easy and very fast via the anchor above the sacrospinous with
M434 EVALUATION OF DIAGNOSTIC TESTS IN URINARY INCONTINENCE (UI) AND RESULTS OF SURGERY FOR UI WITH OR WITHOUT PROLAPSE M.L. Sanchez-Ferrer1 , M.A. Moreno1 , F. Machado1 , P. Vivaracho Terrer1 , A. Nieto1 , J.J. Parrilla1 . 1 Hospital Universitario Virgen de la Arrixaca, Murcia, Murcia, Spain Objectives: Assess the results obtained in the absence/persistence of SUI (stress urinary incontinence) or incontinence ’de novo’ Difference in results of incontinence in patients operated. Assess differences in the diagnosis of UI based on: the urodynamic test compared to incontinence test to assess what has more diagnostic reliability, analyzed according the results obtained. Percentage of patients who required adjustment TOT. Materials: Selected 52 patients operated for UI, pelvic organ prolapse with IU or occult urinary incontinence (OUI). The surgery were vaginal hysterectomy (VH) with or without associated incontinence type transobturator tension-free (TOT). Methods: Statistical analysis was performed using the SPSS program. Results: According to medical history of IU, 43% reported stress urinary incontinence (SUI), 24.5% mixed urinary incontinence (MUI), 9.4% reported urge incontinence (UUI), and 22.6% reported no UI. The surgeries performed were: 30 VH +TOT, 15 TOT, 7 VH Total post-operative results: 85.9% not had SUI, 17.5% had UUI, after anticholinergic treatment only 14%. Breaking down the results of surgery performed: In patients operated TOT 60% had SUI, none of them had SUI after surgery, 13% MUI, 13% IUU ’de novo’; 40% had prior MUI, of these 33% had MUI later. Of the patients operated VH + TOT: Only 10% had postoperative SUI, of which the previously manifested 66% and 33% had occult stress urinary incontinence. 21% of the patients didn’t match the diagnosis made with the urodynamic incontinence in test of 300 ml. Concerning the need to adjust the TOT only 17.5% required postoperative adjustment in all cases except one, the adjustment was to increase the tension. Conclusions: Results were satisfactory. According to the ranges described in the literature. We found that after surgical repair (plasty) of prolapse were resolved on 75% of cases of IUU. Comparing results of TOT with or without VH we find that overall results are slightly better for isolated TOT. We also compared the diagnostic test of incontinence in medical consultation compared with urodynamic study and the results were: 21.15% of cases no diagnosis agreed, but we have observed that when different if only one of them diagnosed with SUI, incontinence surgery was performed and postoperative result was satisfactory. In our sample were adjusted to 17% of TOT ± VH thereafter and we think this action improved our results. M435 POSTPARTUM URINARY DISORDERS M.F. Nozar1,2 , F. Aroztegui2 , M. Kouyoumdjian2 , T. Bengoechea2 , Z. Caraballo2 , D. Greif1,2 , L. Briozzo1,2 . 1 Gynecology, School of Medicine. University of the Republic, Montevideo, Uruguay; 2 Obstetric and Gynecology Department A, Pereira Rossell Hospital, Montevideo, Uruguay Objectives: To assess the prevalence of postpartum urinary disorders and their relationship to birth-related variables. Materials: Population: 140 women between 18 and 40 years, with term pregnancies, live fetuses, and no history of voiding dysfunction prior to delivery. Methods: Prospective study. Place: maternity of the Pereira Rossell Hospital, Montevideo, Uruguay. Period: November 15 to December 14, 2011. Was assessed the onset of voiding disorders related to: route of delivery, parity, perineal laceration, episiotomy, and birth weight.
S671
The survey of the Mountain States Urogynecology, Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) by telephone follow-up at 7 and 30 days of birth was applied. Results: The mean population age was 25.5 years. 62 patients (44%) had voiding dysfunction postpartum. Of these last, 40% referred urgency, 26% stress urinary incontinence, 19% difficulty bladder emptying and 40% genital or lower abdominal pain after 7 days of delivery. Whereas at 30 days postpartum frequency of these symptoms was: 48%, 39%, 18% and 26%, respectively. 48% of vaginal deliveries, 43% of instrumental deliveries and cesarean sections 34% had a postpartum disorder. 57% of the patients who had a birth that higher than 4000 grams had some symptom. 31% and 45% of symptomatic patients referred involvement in daily activities and 29% and 44% of your emotional health at 7 and 30 days respectively. Conclusions: Postpartum urinary disorders are frequents en this population. Women may have multiple symptoms that often go unnoticed, resulting in impact to the biological, social and sexual live. M436 THE ROLE OF MESH REPAIR IN VAGINAL PROLAPSE R. Singh1 , V.P. Singh2 , L. Ravikanti2 . 1 Palmerston North Hospital, Palmerston North, New Zealand; 2 Waikato Hospital, Hamilton, New Zealand Objectives: 1. To assess the efficacy of vaginal mesh repair in patients with paravaginal defects. 2. To compare mesh systems available worldwide. 3. To identify complications and compare our results with other investigators worldwide. Materials: Single surgeon/supervision, including all patients undergoing customized Gynemesh repair for cystocele. Patients were followed up, data analyzed & compared with others systems/ researchers worldwide. Methods: Multicentric study analyzing data over time. Includes objective, subjective and patient quality of life indices. Review of literature worldwide & comparison of results. Results: Newer techniques/materials are contantly being developed indicating better understanding and a felt need for improvement in management techniques, and need for better results and further reducing risks/complications. Most patients in our study were in the 41–70 age group with mainly stage 3 prolapse. 36% (41/114) had previous surgery for prolapse. 95/114 needed anterior & posterior mesh repair. 21/114 needed a concomitant suburethral sling. Subjective & objective cure rates were 100% and 92% respectively. 14/93 & 6/114 developed short term denovo USI & buttock pain. 4/114 developed mesh erosion. Complications decreased with increasing experience. Conclusions: Our understanding of the mechanism of prolapse and optimal management is evolving. Our Technique is a quick, safe, reliable & less expensive than Mesh systems & with fewer complications than most other techniques. The Use of prosthesis have improved results & gained acceptance over time. Newer products/techniques give us reason to hope for improvement in quality of life & a better future for our patients but challenges remain. M437 NEW DEVICE TO SACROSPINOUS SUSPENSION OF APICAL PROLAPSE OR GREAT CYSTOCELE BY ANTERIOR APPROACH J. Elias1 , A. Carbone1 , A. Gaspar1 . 1 Sociedad de Obstetricia y Ginecologia de Buenos Aires (SOGIBA), Buenos Aires, Argentina Objectives: The most modern concepts of anatomy and physiology of prolapse (Prof. DeLancey – Lisbon 2011) indicate the need for all large anterior prolapse repairs to suspensions or reinforcements at level 1. We treated a group of patients with a new device, designe by the company for Argentina Promedon, that makes it easy and very fast via the anchor above the sacrospinous with